ArticleCanadian Urological Association journal = Journal de l'Association des urologues du Canada2019
Quality and cost assessment of Canadian Urological Association microscopic hematuria guidelines in clinical practice: Turning urine into gold.
Article in Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
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Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it, 7 citations in OpenAlex.
- Inappropriate use of clinical practices in Canada: a systematic review.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2022Pooled it
- Genitourinary malignancy among patients presenting with microscopic hematuria in Northwestern Ontario.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2026Article
- Taking a more critical look at the use of costly and invasive testing.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2019Article
- Optimizing management of patients with microhematuria: Gold down the drain?Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2019Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionAsymptomatic microscopic hematuria (AMH) is defined in the Canadian Urological Association (CUA) guideline as >2 red blood cells (RBCs) per high-powered field (HPF). Our objective was to evaluate guideline adherence for AMH at our center. Secondarily, we aimed to identify areas of the guideline that can be optimized.
methodsWe retrospectively reviewed 875 consecutive adults referred to two urologists for hematuria between June 2010 and June 2016. Patient characteristics, risk factors, and outcomes were added to an encrypted Research Electronic Data Capture (REDCap) database. Evaluation of microscopic hematuria reporting was performed by analyzing 681 urine samples reported as 1-5 RBC/HPF. Healthcare costs were obtained from Alberta Health Services (AHS), Data Integration and Management Repository (DIMR), and Alberta Society of Radiologists (ASR).
resultsOf the 875 patients referred with hematuria, 400 had AMH. Overall, 96.5% completed evaluation consistent with the CUA guideline. The incidence of pathology requiring surgical intervention was 21/400 (5%) with a 0.8% rate (3/400) of urothelial cell carcinoma (UCC) (non-invasive, low-grade). No malignancy was found in non-smokers with normal cytology, normal imaging and <50 RBC/HPF; 44% had AMH in the 1-5 RBCs/HPF range. Only 41% (279/681) of urine samples categorized as 1-5 RBCs/ HPF had guideline-defined microscopic hematuria. By changing local microscopic hematuria reporting to differentiate 1-2 and 3-5 RBCs/HPF, we estimate $745 000 in annual savings.
conclusionsAt our center, CUA AMH guideline adherence is high. We did not find malignancy in non-smokers with normal cytology, imaging and <50 RBC/HPF. We identified and changed regional microscopic hematuria reporting to fit the CUA definition, eliminating unnecessary investigations and healthcare costs.
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Registered trials
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